Abstract A13: Evaluation of the culturally and linguistically tailored liver cancer education program for Asian Americans in Maryland

Abstract

Abstract Background: Asian Americans (AAs), particularly those from hepatitis B endemic countries, are at greater risk of contracting hepatitis B virus (HBV) infection. Chronic HBV patients are 200 times more likely to develop liver cancer than individuals without the infection. HBV screening can help AAs manage the HBV infection, but few take advantage of screening. The Maryland Asian American Liver Cancer Education Program, a randomized controlled trial, implemented culturally and linguistically tailored liver cancer education to 877 adult AAs including Korean, Chinese and Vietnamese Americans; recruited through community-based organizations. The intervention group participated in an educational HBV presentation, viewed a role play video, and received a photonovel and a list of Asian specialists. The presentation, role play video and photonovel were developed from formative research and prepared in ethnic languages. The control group, on the other hand, received only an English brochure on HBV. Objective: To examine the effectiveness of the culturally and linguistically tailored program in increasing hepatitis B screening rates and HBV knowledge at a six month follow-up and to analyze the factors that made the intervention successful. Methods: HBV screening rates and knowledge scores of participants without HBV screening at the baseline were followed-up and compared with the intervention and the control group at the post test. Motivating factors for those who got HBV screening were analyzed at the post-test. Results: There were 466 respondents who reported that they had not been screened for HBV at the baseline, including 245 individuals in the intervention group and 221 in the control group. Of those, 358 (76.8%) participated in the post-test; the overall attrition rate was 23.2%. There was no significant difference in the attrition rates between the intervention group (22.9%) and the control group (23.5%) (p=0.86). Two-way ANOVA showed no significant differences in baseline characteristics of drop-outs in the groups. The HBV screening rate was significantly higher in the intervention group (25.9%) than that of in the control group (4.7%) (p<0.001). At the baseline, there was no significant difference in the average knowledge scores on HBV transmission mode and sequelae between the groups. However, after the intervention, the average knowledge scores were significantly higher in the intervention group (7.05, 5.25) than the control group (5.10, 4.51) (p<0.0001 for both). 85.7% of 49 respondents who got screening in the intervention group reported that the intervention program motivated them to get screened. In particular, the presentation on HBV in ethnic languages was considered to be the most effective in motivating the participants to get screened, followed by the role play video and photonovel. Ethnicity specific analyses showed that Korean participants had the highest follow-up rates at the post-test (85.6%) whereas Vietnamese participants had the lowest follow-up rates (68.6%). However, there was no significant difference in the attrition rates between the intervention and control groups within ethnic groups. Ethnicity specific analyses confirmed that the intervention was a motivator for screening behavior and it was very effective in increasing the knowledge score on HBV transmission mode. The culturally and linguistically tailored liver cancer program was successful in increasing HBV screening rates and HBV knowledge. This conclusion was consistent across the three subgroups. The HBV presentation, role play video, and photonovel in ethnic languages were key components that motivated screening behavior. This effective liver cancer education program should be replicated in other AA communities. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A13.